Ticagrelor reduced 30-day mortality to 34.1% versus 54.6% with clopidogrel in AMICS patients, with lower MACE and no increase in major bleeding.
Does ticagrelor reduce 30-day all-cause mortality compared to clopidogrel in patients with acute myocardial infarction-associated cardiogenic shock?
In patients with acute myocardial infarction-associated cardiogenic shock, ticagrelor was associated with significantly lower 30-day mortality and MACE compared to clopidogrel, without increasing major bleeding.
Absolute Event Rate: 0% vs 0%
Abstract Background Cardiogenic shock secondary to acute myocardial infarction (AMICS) is a critical condition with significant hemostatic challenges. Despite the widespread use of P2Y12 inhibitors, current evidence comes primarily from stable populations. This study aimed to compare the efficacy and safety of ticagrelor versus clopidogrel in a propensity-matched cohort of AMICS patients. Methods We conducted a single-center retrospective study to evaluate the impact of ticagrelor versus clopidogrel in AMICS patients receiving dual antiplatelet therapy (DAPT), hospitalized between 2016 and 2024. Propensity score matching was performed on a cohort of 151 patients (103 on clopidogrel; 48 on ticagrelor) using a 1:1 matching protocol without replacement (matching tolerance 20%). Matching variables included age, sex, chronic kidney disease (CKD), peak troponin levels (pTn), occurrence of cardiac arrest, and initial SCAI shock classification. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial reinfarction, stroke or transient ischemic attack, and embolic events, as well as major bleeding events, defined as BARC ≥3. Results A total of 88 patients were included, 44 within each group, with a mean age of 60.5 ± 11 years, 71.6% male, 44.3% presenting in SCAI-C, and 47.7% on mechanical circulatory support (MCS), including IABP, VA-ECMO, and/or Impella. At 30-day follow-up, 39 patients (44.3%) had died. Baseline characteristics were well balanced between groups, including age (p=0.138), sex (p=0.813) and SCAI shock classification (p=0.910)–Table 1. Although not statistically significant, other antithrombotic therapies showed numerical variations between groups. Anticoagulation was more common in clopidogrel-treated patients (70.5% vs. 56.8%), whereas Gp IIb/IIIa antagonists were more frequent in those receiving ticagrelor (20.5% vs. 11.4%). Ticagrelor was associated with a significantly lower 30-day mortality rate (34.1% vs. 54.6%; Log-rank p=0.018) -Figure 1, and reduced MACE incidence (34.1% vs 56.8%; Log-rank p=0.018) -Figure 2. In the subgroup with MCS the magnitude of benefit was similar (OR 0.419 95% CI=0.159-1.101; p=0.078), despite not reaching statistical significance. No significant differences were observed between groups regarding the incidence of major bleeding events (63.6% vs. 59.1%; OR 1.212 95% CI=0.513 - 2.861; p=0.662). Conclusions In this propensity score-matched analysis of AMICS patients receiving DAPT, ticagrelor was associated with significantly lower 30-day mortality and MACE rates compared to clopidogrel, without a corresponding increase in major bleeding risk. These findings may suggest a potential benefit of ticagrelor in this high-risk population; however, further prospective studies are needed.
Presume et al. (Sat,) reported a other. Ticagrelor reduced 30-day mortality to 34.1% versus 54.6% with clopidogrel in AMICS patients, with lower MACE and no increase in major bleeding.